Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study (MONICA/KORA).
Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study (MONICA/KORA).
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DOI：
10.1371/journal.pmed.1000314
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发表时间：
2010-07-27
期刊：
影响因子：
15.8
通讯作者：
Kääb S
中科院分区：
文献类型：
--
作者：
Sinner MF;Reinhard W;Müller M;Beckmann BM;Martens E;Perz S;Pfeufer A;Winogradow J;Stark K;Meisinger C;Wichmann HE;Peters A;Riegger GA;Steinbeck G;Hengstenberg C;Kääb S
在一项中欧中年人人群队列研究中，Stefan Kääb及其同事发现心电图早期复极模式与死亡风险之间存在关联。在一项病例对照研究中，心电图上的早期复极模式（ERP）与特发性心室颤动和心脏骤停有关，并与芬兰社区样本中的心血管死亡率有关。我们试图通过一项大型、前瞻性、基于人群的病例队列研究（心血管疾病和状况监测[MONICA]/KORA[奥格斯堡地区合作卫生研究]）来确定ERP患病率及其与心脏和全因死亡率的关系，该研究由中欧血统的个体组成。应用病例队列设计分析了1945名年龄在35-74岁之间的参与者的心电图，代表了6213名个体的源人群。平均随访时间为18.9年。死亡原因通过死亡证明中记录的国际疾病分类（ICD-9）代码第九次修订确定。erp对死亡率的影响由加权Cox比例风险模型确定。本研究中ERP患病率为13.1%。ERP与心脏和全因死亡率相关，在年轻人和男性中最为明显；明显的erp -年龄相互作用（p = 0.005）。Age-stratified分析显示风险比率(小时)心脏死亡率为1.96(95%可信区间(CI) 1.05 - -3.68, p = 0.035)男女双方为2.65 (95% CI 1.21 - -5.83, p = 0.015),男性在35至54岁y要高许多。一个劣质的本地化ERP进一步ERP-attributable心脏死亡率增加小时3.15 (95% CI 1.58 - -6.28, p = 0.001)为两性和4.27 (95% CI 1.90 - -9.61, p < 0.001),男性在35至54岁y要高许多。小时全因死亡率较弱但达到意义。我们发现以人群为基础的中年个体队列中ERP的患病率很高。在35岁至54岁的个体中，ERP与心脏死亡风险增加约2至4倍相关。ERP定位较差与风险增加尤其相关。在发达国家，心血管疾病——影响心脏和血液循环的疾病——是导致死亡的主要原因，请参见文章后面的编辑总结。大约一半的心血管死亡发生在心脏突然停止跳动（心脏骤停）时。四个心室的肌肉壁以固定的方式收缩，将血液泵入全身。心脏内部的电系统控制着这些收缩的速度和节奏，如果这个系统出了问题，就会出现异常的心跳或“心律失常”。一些心律失常——特别是心室颤动，即两个下心室的壁颤动或“颤动”而不是泵送——会导致心脏骤停和立即失去意识。95%的病例在几分钟内死亡，但立即心肺复苏术（CPR；胸部按压以泵送心脏和通过口对口复苏使肺部膨胀）可以使人存活，直到使用除颤器恢复正常心跳。心脏骤停后幸存下来的人可以服用抗心律失常药物或植入起搏器来稳定心跳。跳动的心脏会产生微小的电波，可以通过皮肤上的电极检测到。这些波的模式（心电图或ECG）提供有关心脏健康的信息。在心电图上经常看到的一种波型是“早期复极模式”（ERP），一些研究表明它与心源性死亡风险增加有关。在MONICA/KORA前瞻性、基于人群的病例队列研究中，研究人员调查了ERP的患病率（ERP人群的比例）及其与心脏相关问题（心脏死亡率）和任何原因（全因死亡率）死亡的关系。MONICA项目（监测心血管疾病的趋势和决定因素）研究了21个国家1000万人的心血管疾病；KORA是指在德国奥格斯堡地区进行的研究。在前瞻性研究中，研究参与者的特定基线特征被确定，参与者被跟踪观察谁经历了预定的结果。病例队列研究调查随机选择的原始研究参与者的亚队列（亚组）和任何经历预定结果的参与者，而不是所有参与者。研究人员采用病例队列研究设计，从大约6000人的源人群中选择了1945名年龄在35-74岁之间的MONIKA/KORA参与者。他们分析了该亚队列的心电图（记录于1984-1985年或1989-1990年），并确定了在18.9年平均随访期间死亡的参与者的死亡原因。研究人员报告说，研究中ERP的总体患病率为13.1%，ERP与心脏死亡率有关，特别是在年轻人和男性参与者中。具体来说，在35-54岁的男性和女性中，ERP与心脏死亡的风险增加了近一倍。在35-54岁的男性中，患有ERP与心脏死亡风险增加2.65倍相关。在这一年龄组中，定位于心脏底部（下定位）的ERP与心脏死亡风险增加相关，在两性中增加3倍以上，在男性中增加4倍以上。最后，ERP也与全因死亡率风险增加显著相关，但与心脏死亡率的相关性较弱。这些发现表明，在MONICA/KORA研究中，ERP在中年人中的患病率很高（比以前报道的要高一些）。他们还显示，在35 - 54岁的人群中，尤其是男性中，ERP与心源性死亡风险之间存在明确的关联，但由于研究设计的原因，这些发现并未表明ERP实际上会导致心源性死亡；它可能只是一个易感性标记。研究人员指出，与ERP相关的心源性死亡风险增加与其他一些ECG异常相关的风险增加相似。然而，尽管对ERP定位较差的年轻人可能值得特别关注，但在没有症状和没有心源性猝死家族史的人身上发现ERP不应该导致进一步的调查或任何预防性治疗，他们建议，因为这类人发生心脏骤停的绝对风险非常低。请通过本摘要的在线版本http://dx.doi.org/10.1371/journal.pmed.1000314访问这些网站。美国国家心肺和血液研究所提供心血管疾病的信息，包括心脏骤停和心律失常，美国心脏协会也提供关于心源性猝死和心律失常的信息，德国心脏学会（Deutsche Gesellschaft for cardiologie）和德国心脏基金会（Deutsche Herzstiftung）提供关于心血管疾病的进一步信息（德文），心律基金会提供关于心律失常各方面的信息，Leducq基金会反对心源性猝死联盟提供信息关于心脏骤停MedlinePlus提供了关于心脏骤停和心律失常的其他资源的链接（英语和西班牙语）MedlinePlus百科全书有一个关于心电图的页面（英语和西班牙语）诺贝尔基金会提供了一个交互式心电图游戏关于MONICA项目和KORA研究的更多信息或可用
In a population-based cohort study of middle-aged people in Central Europe, Stefan Kääb and colleagues find an association between electrocardiographic early repolarization pattern and mortality risk. Early repolarization pattern (ERP) on electrocardiogram was associated with idiopathic ventricular fibrillation and sudden cardiac arrest in a case-control study and with cardiovascular mortality in a Finnish community-based sample. We sought to determine ERP prevalence and its association with cardiac and all-cause mortality in a large, prospective, population-based case-cohort study (Monitoring of Cardiovascular Diseases and Conditions [MONICA]/KORA [Cooperative Health Research in the Region of Augsburg]) comprised of individuals of Central-European descent. Electrocardiograms of 1,945 participants aged 35–74 y, representing a source population of 6,213 individuals, were analyzed applying a case-cohort design. Mean follow-up was 18.9 y. Cause of death was ascertained by the 9th revision of the International Classification of Disease (ICD-9) codes as documented in death certificates. ERP-attributable effects on mortality were determined by a weighted Cox proportional hazard model adjusted for covariables. Prevalence of ERP was 13.1% in our study. ERP was associated with cardiac and all-cause mortality, most pronounced in those of younger age and male sex; a clear ERP-age interaction was detected (p = 0.005). Age-stratified analyses showed hazard ratios (HRs) for cardiac mortality of 1.96 (95% confidence interval [CI] 1.05–3.68, p = 0.035) for both sexes and 2.65 (95% CI 1.21–5.83, p = 0.015) for men between 35–54 y. An inferior localization of ERP further increased ERP-attributable cardiac mortality to HRs of 3.15 (95% CI 1.58–6.28, p = 0.001) for both sexes and to 4.27 (95% CI 1.90–9.61, p<0.001) for men between 35–54 y. HRs for all-cause mortality were weaker but reached significance. We found a high prevalence of ERP in our population-based cohort of middle-aged individuals. ERP was associated with about a 2- to 4-fold increased risk of cardiac mortality in individuals between 35 and 54 y. An inferior localization of ERP was associated with a particularly increased risk. Please see later in the article for the Editors' Summary Cardiovascular diseases—disorders that affect the heart and the circulation—are the leading cause of death in the developed world. About half of cardiovascular deaths occur when the heart suddenly stops pumping (sudden cardiac arrest). The muscular walls of the four heart chambers contract in a set pattern to pump blood around the body. The heart's internal electrical system controls the rate and rhythm of these contractions and, if this system goes wrong, an abnormal heart beat or “arrhythmia” develops. Some arrhythmias—in particular, ventricular fibrillation in which the walls of the two lower heart chambers quiver or “fibrillate” instead of pumping—can cause sudden cardiac arrest and immediate loss of consciousness. Death follows within minutes in 95% of cases but immediate cardiopulmonary resuscitation (CPR; chest compression to pump the heart and inflation of the lungs by mouth-to-mouth resuscitation) can keep a person alive until a defibrillator can be used to restore the normal heart beat. People who survive sudden cardiac arrest can be given anti-arrhythmia drugs or have a pacemaker implanted to stabilize their heart beat. The beating heart generates tiny electric waves that can be detected by electrodes on the skin. The pattern of these waves (an electrocardiogram or ECG) provides information about the heart's health. One wave pattern that is often seen on ECGs is the “early repolarization pattern” (ERP), which some studies suggest is associated with an increased risk of cardiac death. Here, the researchers investigate the prevalence of ERP (the proportion of a population with ERP) and its association with death from heart-related problems (cardiac mortality) and from any cause (all-cause mortality) in the MONICA/KORA prospective, population-based case-cohort study. The MONICA Project (MONitoring of Trends and Determinants in CArdiovascular Disease) has studied cardiovascular disease in 10 million people in 21 countries; KORA denotes the study done in the Augsburg region of Germany. In a prospective study, specific baseline characteristics of the study's participants are determined and the participants are followed to see who experiences a predefined outcome. A case-cohort study investigates a randomly selected subcohort (subgroup) of the original participants of a study and any participants who experience the predefined outcome instead of all the participants. The researchers selected 1945 MONIKA/KORA participants aged 35–74 years from a source population of about 6,000 people using a case-cohort study design. They analyzed the ECGs (recorded in 1984–1985 or 1989–1990) of this subcohort and ascertained the cause of death for those participants who died during the 18.9 year average follow-up. The overall prevalence of ERP in the study was 13.1%, report the researchers, and ERP was associated with cardiac mortality, particularly among younger and male participants. Specifically, among men and women aged 35–54 years, having ERP was associated with a nearly doubled risk of cardiac death. Among men aged 35–54 years, having ERP was associated with an increase in the risk of cardiac death by 2.65-fold. An ERP localized to the bottom of the heart (inferior localization) was associated with an increased risk of cardiac death among both sexes by more than 3-fold and among men by more than 4-fold in this age group. Finally, ERP was also significantly associated with an increased risk of all-cause mortality but less strongly than with cardiac mortality. These findings suggest that the prevalence of ERP among the middle-aged people in the MONICA/KORA study is high (and somewhat higher than previously reported). They also show a clear association between ERP and the risk of cardiac death among 35–54-year-old people, particularly among men, but because of the study design, these findings do not show that ERP actually causes cardiac death; it could simply be a susceptibility marker. The researchers note that the increased risk of cardiac death associated with ERP is of a similar size to that associated with some other ECG abnormalities. However, although it might be worth paying special attention to young people with an inferior localization of ERP, finding ERP in a person without symptoms and without a family history of sudden cardiac death should not lead to further investigations or any preventative therapy, they suggest, because the absolute risk of cardiac arrest in such people is very low. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000314. The US National Heart Lung and Blood Institute provides information on cardiovascular conditions, including sudden cardiac arrest and on arrhythmias The American Heart Association also information on sudden cardiac death and on arrhythmias The German Cardiac Society (Deutsche Gesellschaft fr Kardiologie) and the German Heart Foundation (Deutsche Herzstiftung) provide further information (in German) on cardiovascular conditions The Heart Rhythm Foundation provides information on all aspects of heart arrhythmia The Fondation Leducq Alliance Against Sudden Cardiac Death provides information on sudden cardiac arrest MedlinePlus provides links to other resources about cardiac arrest and arrhythmias (in English and Spanish) The MedlinePlus Encyclopedia has a page on electrocardiograms (in English and Spanish) The Nobel Foundation provides an interactive electrocardiogram game More information about the MONICA project and the KORA Study or is available
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通讯作者：
Chakravarti, Aravinda